Promoting value-based care in EDs (PROV-ED)

Aim

To improve value-based care and health service delivery in Queensland Emergency Departments by identifying successfully piloted initiatives, further developing their associated resources, and scaling across the state.

Outcomes

• identification of projects undertaken in individual Queensland Health hospitals or health services that could benefit other emergency departments; helping to stop reinventing the wheel
• provision of resources endorsed at state-wide level, with opportunity to customise based on local requirements
• enabling networking opportunities and dissemination of ideas and innovation at events such as “PROV-ED Pitchfest”; breaking down silos
• initiatives offered on opt-in basis, with guidance and assistance offered to implement
• site-specific evaluation and feedback of initiative outcomes, to help guide implementation and encourage continual improvement and engagement
• demonstration of statewide value-based healthcare improvements in Queensland Health emergency departments.
• local and statewide capacity building for ongoing implementation of quality improvement initiatives resulting in better patient care and experience, and health system efficiency.
• supporting innovation for service improvement by decreasing the time between the emergence of clinical evidence and integration into practice.

Background

Health services, and emergency departments (EDs) in particular, are facing unprecedented demand for services against a backdrop of finite resources. Value-based care is increasingly important, with overuse of low-value care and underuse of high-value care contributing to unnecessary costs and poor health outcomes. To provide efficient and safe healthcare, clinicians must consider the benefits and risks of investigations and treatments, and be aware of options and methods to changing care (1).

Value-based healthcare is not only about costs. The quality of care provided to patients can be enhanced with new developments in clinical care. Improving healthcare provision also reduces overcrowding and improves staff efficiency (reduced stress and cognitive load, improved morale and satisfaction), patient satisfaction, and importantly patient safety (2).

Frontline healthcare workers are championing this cause, developing and implementing valuable, well-considered, innovative initiatives to improve emergency care. Many initiatives are most likely scalable, however there are no clear pathways, and many barriers to dissemination. PROV-ED has fostered a culture of innovation, improvement, and capacity building, and promoted collaboration both within Queensland Health and with external stakeholders.

Outcomes to date demonstrate that PROV-ED has contributed to efficiency increases and cost savings, improved patient safety, clinician empowerment (e.g. resources to decrease cognitive load, work to scope of practice), and staff satisfaction, all of which contribute to improved health service delivery and patient care in Queensland EDs.

Discussion

By facilitating the adoption of these successfully piloted initiatives, PROV-ED is helping to spread innovation beyond hospital and HHS boundaries.

PROV-ED also builds capacity building for health service redesign and quality improvement through multidisciplinary clinician engagement, workforce skills development and by creating a model for widespread implementation of initiatives.

References

1. Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. The Lancet. 2017.
2. Porter ME. A Strategy for Health Care Reform — Toward a Value-Based System. New England Journal of Medicine. 2009;361(2):109-12.

Further Reading

Read more about Pitchfest on the Clinical Excellence Queensland blog.

Resources

Public resources

Pitchfest May 2019 Program [PDF 207.05 KB]